By Katharina Pracon, MD
I wasn't planning to write this.
I spent several days in New York to listen - to talk to women about their health, their bodies, their lives. I'm a doctor. I do this every day in Oslo. I thought I knew roughly what I'd hear.
I didn't.
Not because American women are so different from Norwegian women. But because the gap between what they knew and what they deserved to know was wider than I expected. And because what struck me most wasn't a diagnosis, a disease, or a deficiency.
It was what women had quietly started calling normal.
"It's probably nothing."
Almost every conversation started this way.
Women would lower their voice, then describe symptoms — exhaustion that didn't go away with rest, moods that felt borrowed from someone else, cycles that no longer made sense.
And before I could respond, they'd add: "But I know everyone feels like this. It's probably nothing."
That sentence stayed with me for the entire trip.
Because here's what I know as a doctor: that pre-emptive self-dismissal doesn't come from nowhere. It's learned. It happens when women bring real symptoms to a system that doesn't have time — or tools — to look deeper. Sometimes they get sent home with nothing. Sometimes with something worse: a prescription that treats the surface while the root cause goes uninvestigated.
One woman I spoke to had been prescribed anxiety medication. What she actually had were early perimenopause symptoms. The medication didn't help — it was answering the wrong question. She described it as a band-aid: something to quiet her down, not something to find out what was actually wrong.
She is not an exception.
When women are dismissed often enough, they stop expecting to be believed. They start doing the dismissing themselves. That's not a personality trait. That's what repeated failure of care looks like from the inside. Your symptoms are not dramatic. They are data. And you deserve a doctor who treats them that way.
Exhaustion has become a personality trait
The most common thing I heard wasn't a symptom. It was an identity. "I'm just the tired one." "I've always been someone who needs a lot of coffee." "I've just accepted that this is how I feel."
Fatigue is one of the most underinvestigated symptoms in women's medicine. It gets attributed to stress, to motherhood, to being busy, to personality–before anyone has checked thyroid function, iron stores, sleep architecture, cortisol patterns, or hormonal status.
Chronic fatigue is not a character flaw. It is not inevitable. In many cases, it has a cause–and causes can be investigated, and sometimes treated. ‘Tired’ is a symptom. Not an identity. If you have been exhausted for months and nobody has looked for a reason, that is worth pushing for.
Women know more about skincare than their own hormones
I asked several women if they knew what perimenopause was. Most had a vague idea. "Isn't that menopause?" "It happens in your 50s, right?" Then I asked about their skincare routines. They could tell me every ingredient, every step, every product - and why. Retinol for cell turnover. Niacinamide for barrier repair. SPF as non-negotiable.
I am not criticizing this. Understanding your skin is legitimate. But I noticed something: women had been extensively educated about the surface of their bodies, and almost completely left in the dark about what was happening underneath.
We live in an era of extraordinary access to health information. And yet the gap between what women know about their hormones and what they know about their serums is enormous - and that gap is not an accident. It reflects where the marketing money goes, and where the medical conversations don't.
Your hormones affect your mood, your memory, your sleep, your metabolism, your bone density, your cardiovascular health, and your experience of being in your own body. They deserve at least as much attention as your skincare routine.
Perimenopause starts earlier than anyone told them
This was the conversation that happened the most.
Women in their late 30s and early 40s describing years of symptoms - disrupted sleep, brain fog, anxiety that arrived out of nowhere, cycles that had become unpredictable, a general sense of feeling unlike themselves–who had been told, by multiple doctors, that it was stress, burnout, or depression.
Some had been put on antidepressants. Some had been told to exercise more. Most had been told to come back if things got worse.
What none of them had been told was that perimenopause–the transition phase before menopause–can begin as early as the mid-30s. That it is not a single event but a gradual hormonal shift that can span a decade. That the symptoms are real, they have a physiological explanation, and there are options.
I want to be clinically precise here: not every woman will experience significant perimenopausal symptoms early, and symptoms like sleep disruption and mood changes can have many causes. Individual evaluation matters. But if you are a woman in your late 30s or 40s who has been feeling unlike yourself for a while and nobody has raised the possibility of hormonal change–it is worth asking about.
The earlier you understand what is happening in your body, the more informed your choices will be.
They were optimizing everything. Except sleep.
This one surprised me more than I expected. The women I spoke to were genuinely health-conscious. Many were taking supplements, tracking their nutrition, and doing regular exercise. Several mentioned cold exposure, intermittent fasting, or elaborate morning protocols.
But when I asked about sleep, the tone shifted.
"I get about five hours. Maybe six on a good night." "I know I should sleep more. But what can you do?" "I'll sleep when I'm dead." (Said with a laugh that didn't quite reach her eyes.)
I understand this. I am a doctor and I have worked night shifts. I know what it is to be a woman with too much to do and not enough hours. But I also know what the research says, and I would not be doing my job if I did not say this clearly:
Sleep is not a lifestyle variable you can optimize around. It is a biological requirement.
During sleep, your body repairs damaged DNA. Your brain clears metabolic waste products through the glymphatic system–including proteins associated with neurodegeneration. Growth hormone is released. Cortisol, your primary stress hormone, resets. Immune function consolidates. Memory is processed and stored.
Chronic sleep deprivation–consistently getting under seven hours–is associated with increased risk of cardiovascular disease, metabolic dysregulation, impaired immune function, and accelerated cognitive aging. No supplement, no protocol, and no morning routine compensates for what happens in the body when sleep is chronically insufficient.
If you are doing everything else right and still not sleeping, that is the thing to fix first.
Prevention had become a luxury. Not a habit.
Something that came up again and again was preventive care. Not because the women I spoke to didn't want it, they did. But getting there kept running into the same walls: cost, insurance, not knowing where to start. Several hadn't had basic bloodwork in years. Not out of indifference. Life just made it hard.
What struck me wasn't the system. It was how many women had quietly stopped asking.
I know access isn't equal, and I know this isn't always simple. But where it is possible–even partially–it's worth pushing for. Your iron levels, thyroid function, blood glucose, hormonal status, and vitamin D can explain a great deal about how you feel. And all of them are modifiable when something is off.
You cannot make informed decisions about your health without knowing your baseline. That is basic clinical information–and all of it is modifiable when something is off.
But I also noticed something else. The same women were spending significant money on advanced fitness equipment and programs–used intensely for a few weeks, then abandoned. The all-or-nothing approach. Big investment, burnout, guilt, repeat.
In Norway, we tend to think differently. The focus is on small things done consistently: walking to work, eating real food most of the time, taking breaks, moving in ways that feel good. It sounds almost embarrassingly simple. But the body responds to consistency far more than intensity. A 20-minute walk every day is not glamorous–but the evidence for its effect on cardiovascular health, metabolic function, mood, and longevity is remarkable. It is one of the most well-researched health interventions we have.
Your body doesn't want a perfect month. It wants a reliable Tuesday. I am not naive about the structural barriers in America–they are real and serious. But for those who have some access and have been putting it off: please don't. And while you're at it–consider what the small, consistent daily habits might look like for you. That's where most of the health actually lives.
What I came home thinking
Women's health is not a niche topic. It is not a wellness trend. What I saw in New York was a group of intelligent, capable, health-interested women who deserved better answers. Not because they weren't trying–but because the knowledge, the conversations, and the clinical attention hadn't reached them yet.
We talk a lot about perimenopause now. Hormonal health is having a moment. And that matters. But awareness without action only goes so far.
What actually changes things is this: women understanding what is happening in their own bodies. Doctors taking symptoms seriously instead of normalizing them. A culture that stops treating exhaustion as a badge of honor and starts treating it as a signal worth investigating.
The women I spoke to in New York were not looking for someone to fix them. They were looking for someone to believe them–and to give them the knowledge to understand themselves.
That is not too much to ask.
You are not too sensitive. You are not overreacting. You are a woman whose body has been giving her signals - and you deserve to understand what they mean.
Katharina Pracon is an MD with over 15 years of clinical experience, specializing in sports medicine, based in Oslo, Norway. She writes about women's health, longevity, and Nordic approaches to wellbeing.